TY - JOUR A1 - Stoppel, Relika T1 - Alcohol availability and alcohol-attributable mortality BT - economic implications following a change in sales policy JF - CESifo economic studies : CESifo, a joint initiative of the University of Munich's Center for Economic Studies and the Ifo Institute N2 - It is commonly known that irresponsible alcohol use can have adverse effects. For some people, it results in health problems, for others in productivity loss, and some experience the worst possible outcome of alcohol misuse - death. This paper estimates the effect of reduced alcohol sales hours on alcohol-attributable mortality (AAM) in Estonia. Using novel mortality data from 1997 to 2015, this paper analyzes the effect of alcohol sales policies at both the county level and the country level. By applying the difference-in-differences method and the ARIMA model, this paper finds that the alcohol sales policy reduced AAM to between 1.710 and 2.401 deaths per 100,000 per month, which equals a reduction of 31% to 40% in AAM deaths. These findings suggest that individuals who are the most at risk of dying from alcohol-attributable causes of death benefit remarkably from reduced alcohol availability. KW - health policy KW - mortality KW - public health KW - alcohol Y1 - 2021 U6 - https://doi.org/10.1093/cesifo/ifab008 SN - 1610-241X SN - 1612-7501 VL - 67 IS - 4 SP - 463 EP - 487 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Baritello, Omar A1 - Salzwedel, Annett A1 - Sündermann, Simon A1 - Niebauer, Josef A1 - Völler, Heinz T1 - The Pandora's Box of frailty assessments: Which is the best for clinical purposes in TAVI patients? A critical review JF - Journal of Clinical Medicine N2 - Frailty assessment is recommended before elective transcatheter aortic valve implantation (TAVI) to determine post-interventional prognosis. Several studies have investigated frailty in TAVI-patients using numerous assessments; however, it remains unclear which is the most appropriate tool for clinical practice. Therefore, we evaluate which frailty assessment is mainly used and meaningful for ≤30-day and ≥1-year prognosis in TAVI patients. Randomized controlled or observational studies (prospective/retrospective) investigating all-cause mortality in older (≥70 years) TAVI patients were identified (PubMed; May 2020). In total, 79 studies investigating frailty with 49 different assessments were included. As single markers of frailty, mostly gait speed (23 studies) and serum albumin (16 studies) were used. Higher risk of 1-year mortality was predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95% confidence interval (CI) 6.50–33.30) and lower serum albumin level (highest HR: 3.12; 95% CI 1.80–5.42). Composite indices (five items; seven studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95% CI 2.71–86.10) and 1-year mortality (highest OR: 2.75; 95% CI 1.55–4.87). In conclusion, single markers of frailty, in particular gait speed, were widely used to predict 1-year mortality. Composite indices were appropriate, as well as a comprehensive assessment of frailty. View Full-Text KW - frailty tool KW - TAVI KW - older patients KW - elderly KW - cardiology KW - mortality Y1 - 2021 U6 - https://doi.org/10.3390/jcm10194506 SN - 2077-0383 VL - 10 SP - 1 EP - 17 PB - MDPI CY - Basel, Schweiz ET - 19 ER - TY - JOUR A1 - Neufeld, Maria A1 - Bobrova, Anastacia A1 - Davletov, Kairat A1 - Stelemekas, Mindaugas A1 - Stoppel, Relika A1 - Ferreira-Borges, Carina A1 - Breda, Joao A1 - Rehm, Jürgen T1 - Alcohol control policies in Former Soviet Union countries BT - a narrative review of three decades of policy changes and their apparent effects JF - Drug and alcohol review N2 - Issues The last Soviet anti-alcohol campaign of 1985 resulted in considerably reduced alcohol consumption and saved thousands of lives. But once the campaign's policies were abandoned and the Soviet alcohol monopoly broken up, a steep rise in mortality was observed in many of the newly formed successor countries, although some kept their monopolies. Almost 30 years after the campaign's end, the region faces diverse challenges in relation to alcohol. Approach The present narrative review sheds light on recent drinking trends and alcohol policy developments in the 15 Former Soviet Union (FSU) countries, highlighting the most important setbacks, achievements and best practices. Vignettes of alcohol control policies in Belarus, Estonia, Kazakhstan, Lithuania and Uzbekistan are presented to illustrate the recent developments.
Key Findings Over the past decade, drinking levels have declined in almost all FSU countries, paralleled by the introduction of various alcohol-control measures. The so-called three 'best buys' put forward by the World Health Organization to reduce alcohol-attributable burden (taxation and other measures to increase price, restrictions on alcohol availability and marketing) are relatively well implemented across the countries. Implications In recent years, evidence-based alcohol policies have been actively implemented as a response to the enormous alcohol-attributable burden in many of the countries, although there is big variance across and within different jurisdictions. Conclusion Strong declines in alcohol consumption were observed in the 15 FSU countries, which have introduced various alcohol control measures in recent years, resulting in a reduction of alcohol consumption in the World Health Organization European region overall. KW - alcohol KW - alcohol policy KW - Eastern Europe KW - Former Soviet Union KW - mortality Y1 - 2020 U6 - https://doi.org/10.1111/dar.13204 SN - 0959-5236 SN - 1465-3362 VL - 40 IS - 3 SP - 350 EP - 367 PB - Wiley CY - Hoboken ER - TY - JOUR A1 - Salzwedel, Annett A1 - Jensen, Katrin A1 - Rauch, Bernhard A1 - Doherty, Patrick A1 - Metzendorf, Maria-Inti A1 - Hackbusch, Matthes A1 - Völler, Heinz A1 - Schmid, Jean-Paul A1 - Davos, Constantinos H. T1 - Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine BT - update of the Cardiac Rehabilitation Outcome Study (CROS-II) JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis. Design A systematic review and meta-analysis. Methods Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included. Resulte Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; retrospective controlled cohort studies HR 0.64, 95% CI 0.53-0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI 0.08-0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI 0.54-0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95% CI 0.36-0.77; two out of 10 controlled cohort studies with neutral results). Conclusion CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation. KW - cardiac rehabilitation KW - cardiac rehabilitation delivery KW - acute coronary KW - syndrome KW - coronary bypass grafting KW - coronary artery disease KW - mortality Y1 - 2020 U6 - https://doi.org/10.1177/2047487320905719 SN - 2047-4873 SN - 2047-4881 VL - 27 IS - 16 SP - 1756 EP - 1774 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Premier, Joseph A1 - Fickel, Jörns A1 - Heurich, Marco A1 - Kramer-Schadt, Stephanie T1 - The boon and bane of boldness BT - movement syndrome as saviour and sink for population genetic diversity JF - Movement Ecology N2 - Background: Many felid species are of high conservation concern, and with increasing human disturbance the situation is worsening. Small isolated populations are at risk of genetic impoverishment decreasing within-species biodiversity. Movement is known to be a key behavioural trait that shapes both demographic and genetic dynamics and affects population survival. However, we have limited knowledge on how different manifestations of movement behaviour translate to population processes. In this study, we aimed to 1) understand the potential effects of movement behaviour on the genetic diversity of small felid populations in heterogeneous landscapes, while 2) presenting a simulation tool that can help inform conservation practitioners following, or considering, population management actions targeting the risk of genetic impoverishment. Methods: We developed a spatially explicit individual-based population model including neutral genetic markers for felids and applied this to the example of Eurasian lynx. Using a neutral landscape approach, we simulated reintroductions into a three-patch system, comprising two breeding patches separated by a larger patch of differing landscape heterogeneity, and tested for the effects of various behavioural movement syndromes and founder population sizes. We explored a range of movement syndromes by simulating populations with various movement model parametrisations that range from 'shy' to 'bold' movement behaviour. Results: We find that movement syndromes can lead to a higher loss of genetic diversity and an increase in between population genetic structure for both "bold" and "shy" movement behaviours, depending on landscape conditions, with larger decreases in genetic diversity and larger increases in genetic differentiation associated with bold movement syndromes, where the first colonisers quickly reproduce and subsequently dominate the gene pool. In addition, we underline the fact that a larger founder population can offset the genetic losses associated with subpopulation isolation and gene pool dominance. Conclusions We identified a movement syndrome trade-off for population genetic variation, whereby bold-explorers could be saviours - by connecting populations and promoting panmixia, or sinks - by increasing genetic losses via a 'founder takes all' effect, whereas shy-stayers maintain a more gradual genetic drift due to their more cautious behaviour. Simulations should incorporate movement behaviour to provide better projections of long-term population viability and within-species biodiversity, which includes genetic diversity. Simulations incorporating demographics and genetics have great potential for informing conservation management actions, such as population reintroductions or reinforcements. Here, we present such a simulation tool for solitary felids. KW - Lynx lynx KW - neutral landscape models KW - eurasian lynx KW - natal dispersal KW - home range KW - fragmented landscapes KW - behavioral syndromes KW - habitat loss KW - personality KW - mortality Y1 - 2020 U6 - https://doi.org/10.1186/s40462-020-00204-y SN - 2051-3933 VL - 8 IS - 1 SP - 1 EP - 17 PB - BioMed Central CY - London ER - TY - JOUR A1 - Vaid, Akhil A1 - Somani, Sulaiman A1 - Russak, Adam J. A1 - De Freitas, Jessica K. A1 - Chaudhry, Fayzan F. A1 - Paranjpe, Ishan A1 - Johnson, Kipp W. A1 - Lee, Samuel J. A1 - Miotto, Riccardo A1 - Richter, Felix A1 - Zhao, Shan A1 - Beckmann, Noam D. A1 - Naik, Nidhi A1 - Kia, Arash A1 - Timsina, Prem A1 - Lala, Anuradha A1 - Paranjpe, Manish A1 - Golden, Eddye A1 - Danieletto, Matteo A1 - Singh, Manbir A1 - Meyer, Dara A1 - O'Reilly, Paul F. A1 - Huckins, Laura A1 - Kovatch, Patricia A1 - Finkelstein, Joseph A1 - Freeman, Robert M. A1 - Argulian, Edgar A1 - Kasarskis, Andrew A1 - Percha, Bethany A1 - Aberg, Judith A. A1 - Bagiella, Emilia A1 - Horowitz, Carol R. A1 - Murphy, Barbara A1 - Nestler, Eric J. A1 - Schadt, Eric E. A1 - Cho, Judy H. A1 - Cordon-Cardo, Carlos A1 - Fuster, Valentin A1 - Charney, Dennis S. A1 - Reich, David L. A1 - Böttinger, Erwin A1 - Levin, Matthew A. A1 - Narula, Jagat A1 - Fayad, Zahi A. A1 - Just, Allan C. A1 - Charney, Alexander W. A1 - Nadkarni, Girish N. A1 - Glicksberg, Benjamin S. T1 - Machine learning to predict mortality and critical events in a cohort of patients with COVID-19 in New York City: model development and validation JF - Journal of medical internet research : international scientific journal for medical research, information and communication on the internet ; JMIR N2 - Background: COVID-19 has infected millions of people worldwide and is responsible for several hundred thousand fatalities. The COVID-19 pandemic has necessitated thoughtful resource allocation and early identification of high-risk patients. However, effective methods to meet these needs are lacking. Objective: The aims of this study were to analyze the electronic health records (EHRs) of patients who tested positive for COVID-19 and were admitted to hospitals in the Mount Sinai Health System in New York City; to develop machine learning models for making predictions about the hospital course of the patients over clinically meaningful time horizons based on patient characteristics at admission; and to assess the performance of these models at multiple hospitals and time points. Methods: We used Extreme Gradient Boosting (XGBoost) and baseline comparator models to predict in-hospital mortality and critical events at time windows of 3, 5, 7, and 10 days from admission. Our study population included harmonized EHR data from five hospitals in New York City for 4098 COVID-19-positive patients admitted from March 15 to May 22, 2020. The models were first trained on patients from a single hospital (n=1514) before or on May 1, externally validated on patients from four other hospitals (n=2201) before or on May 1, and prospectively validated on all patients after May 1 (n=383). Finally, we established model interpretability to identify and rank variables that drive model predictions. Results: Upon cross-validation, the XGBoost classifier outperformed baseline models, with an area under the receiver operating characteristic curve (AUC-ROC) for mortality of 0.89 at 3 days, 0.85 at 5 and 7 days, and 0.84 at 10 days. XGBoost also performed well for critical event prediction, with an AUC-ROC of 0.80 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. In external validation, XGBoost achieved an AUC-ROC of 0.88 at 3 days, 0.86 at 5 days, 0.86 at 7 days, and 0.84 at 10 days for mortality prediction. Similarly, the unimputed XGBoost model achieved an AUC-ROC of 0.78 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. Trends in performance on prospective validation sets were similar. At 7 days, acute kidney injury on admission, elevated LDH, tachypnea, and hyperglycemia were the strongest drivers of critical event prediction, while higher age, anion gap, and C-reactive protein were the strongest drivers of mortality prediction. Conclusions: We externally and prospectively trained and validated machine learning models for mortality and critical events for patients with COVID-19 at different time horizons. These models identified at-risk patients and uncovered underlying relationships that predicted outcomes. KW - machine learning KW - COVID-19 KW - electronic health record KW - TRIPOD KW - clinical KW - informatics KW - prediction KW - mortality KW - EHR KW - cohort KW - hospital KW - performance Y1 - 2020 U6 - https://doi.org/10.2196/24018 SN - 1439-4456 SN - 1438-8871 VL - 22 IS - 11 PB - Healthcare World CY - Richmond, Va. ER - TY - JOUR A1 - Nitezki, Tina A1 - Kleuser, Burkhard A1 - Krämer, Stephanie T1 - Fatal gastric distension in a gold thioglucose mouse model of obesity JF - Laboratory Animals N2 - This case report addresses the problem of underreporting negative results and adverse side effects in animal testing. We present our findings regarding a hyperphagic mouse model associated with unforeseen high mortality. The results outline the necessity of reporting detailed information in the literature to avoid duplication. Obese mouse models are essential in the study of obesity, metabolic syndrome and diabetes mellitus. An experimental model of obesity can be induced by the administration of gold thioglucose (GTG). After transcending the blood-brain barrier, the GTG molecule interacts with regions of the ventromedial hypothalamus, thereby primarily targeting glucose-sensitive neurons. When these neurons are impaired, mice become insensitive to the satiety effects of glucose and develop hyperphagia. In a pilot study for optimising dosage and body weight development, C57BL/6 mice were treated with GTG (0.5 mg/g body weight) or saline, respectively. Animals were provided a physiological amount of standard diet (5 g per animal) for the first 24 hours after treatment to prevent gastric dilatation. Within 24 hours after GTG injection, all GTG-treated animals died of gastric overload and subsequent circulatory shock. Animals developed severe attacks of hyperphagia, and as the amount of provided chow was restricted, mice exhibited unforeseen pica and ingested bedding material. These observations strongly suggest that restricted feeding is contraindicated concerning GTG application. Presumably, the impulse of excessive food intake was a strong driving force. Therefore, the actual degree of suffering in the GTG-induced model of hyperphagia should be revised from moderate to severe. KW - appetite KW - distress KW - refinement KW - mortality Y1 - 2018 U6 - https://doi.org/10.1177/0023677218803384 SN - 0023-6772 SN - 1758-1117 VL - 53 IS - 1 SP - 89 EP - 94 PB - Sage Publ. CY - Thousand Oaks ER - TY - JOUR A1 - Espe, Katharina M. A1 - Raila, Jens A1 - Henze, Andrea A1 - Krane, Vera A1 - Schweigert, Florian J. A1 - Hocher, Berthold A1 - Wanner, Christoph A1 - Drechsler, Christiane T1 - Impact of vitamin A on clinical outcomes in haemodialysis patients JF - Nephrology, dialysis, transplantation N2 - Background. Patients on maintenance haemodialysis treatment experience an excessive risk of cardiovascular disease and mortality. The vitamin A concentration is known to be higher in these patients compared to the general population where elevated vitamin A concentrations are associated with adverse outcome. The impact of vitamin A on morbidity and mortality in end-stage renal disease patients is controversial and is the topic of this study. Methods. We analysed plasma retinol and retinol-binding protein 4 (RBP4) in 1177 diabetic haemodialysis patients, who participated in the German Diabetes and Dialysis Study (median follow-up 4 years). By Cox regression analyses hazard ratios (HRs) were determined for pre-specified, adjudicated end points according to baseline concentrations. Results. Patients had a mean age of 66 +/- 8 years, mean retinol and RBP4 concentrations of 3.28 (0.71-7.44) and 4.02 (1.28-10.1) mu mol/L, respectively. Patients with retinol concentrations in the first quartile (<2.6 mu mol/L) had an almost 2-fold increased risk of all-cause mortality compared to patients of the fourth quartile [>3.9 mu mol/L; HR 1.81, 95% confidence interval (CI) 1.43-2.30]. There was a strong association between low retinol and the risk of sudden cardiac death (SCD, HR 2.22, 95% CI 1.41-3.50) and fatal infection (HR 2.19, 95% CI 1.26-3.82). Patients with RBP4 concentrations in the lowest quartile (<3.0 mu mol/L) were more likely to die of any cause (HR 1.43, 95% CI 1.14-1.80), experience SCD (HR 1.97, 95% CI 1.28-3.03) and cardiovascular events (HR 1.43, 95% CI 1.10-1.85). Conclusion. This large cohort study shows a strong association of low retinol and RBP4 concentrations with SCD and all-cause mortality in diabetic haemodialysis patients. KW - haemodialysis KW - mortality KW - retinol KW - retinol-binding protein 4 KW - sudden death Y1 - 2011 U6 - https://doi.org/10.1093/ndt/gfr171 SN - 0931-0509 VL - 26 IS - 12 SP - 4054 EP - U583 PB - Oxford Univ. Press CY - Oxford ER -